Provider Demographics
NPI:1427221910
Name:ACTIVE REHABILITATION P.C.
Entity Type:Organization
Organization Name:ACTIVE REHABILITATION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:856-596-4247
Mailing Address - Street 1:129 WAGONWHEEL CT
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4718
Mailing Address - Country:US
Mailing Address - Phone:856-596-4247
Mailing Address - Fax:856-596-6289
Practice Address - Street 1:129 WAGONWHEEL CT
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4718
Practice Address - Country:US
Practice Address - Phone:856-596-4347
Practice Address - Fax:856-596-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00286500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099856Medicare PIN